Diet for Hidradenitis Suppurativa

Diet and Hidradenitis Suppurativa

In my opinion, the concept of using diet to help HS, and considering it the end-all-be-all is one of the biggest mistakes the HS community makes when working toward HS remission. There’s no cure for HS, but hope is greater than a cure. And I believe hope is found in attacking inflammation from all angles. Diet is only one approach to reducing the inflammation that causes HS lesions. Focusing only on one factor is a mistake the HS community makes over and over again. That said, it’s not my research that led me to realize how much stress impacts inflammation. Personal experience made all the difference. When my stress suddenly disappeared and my HS resolved spontaneously shortly thereafter—that’s what woke me up. I had lost all hope, only to find the answer I’d been looking for on accident!

What is Diet?

If you’ve spent any time in the online HS community, you’ve likely seen a lot of discussions revolving around diet and how diet can be used to improve HS symptoms. There are all different sorts of diets, but what is a diet exactly? A diet is really just a description of what we’re eating at a particular moment in time or over a certain period of time. We can describe it in all sorts of different ways, whether it’s as a vegan diet, low-carb diet, ketogenic diet, carnivore diet, auto-immune protocol diet, Indian diet or Mediterranean diet. There are all sorts of different diets. Vegans might get nutrients from plant-based products; low-carb and keto dieters tend to eat fewer than 50g of carbohydrates per day, and carnivores eat a diet entirely comprised of animal-products and thus consume near zero carbs. Regardless of how and why you eat what you do, the word diet is really just a description of what you eat. I don’t believe that any particular diet is right for everyone all the time. The goal then really, is eating real food, regardless of how we describe it—not food that comes packaged to sit on a shelf for months at a time on the interior aisles of a grocery store. When we eat real food, and avoid food-like-products marketed to us as food, we move closer toward good health, regardless of what direction we go with our particular diet.

The Purpose of Diet

So now that we know what a diet is, what is the purpose of our diet? This is an oversimplification really, but the purpose of eating and our diet is to get the nutrients and vitamins our bodies need to survive—and thrive—through three different macro nutrient groups. The macro nutrient groups are protein, fat, and carbohydrates.

Protein: Diet Building Blocks

If you’re going to build a home, you need a structure. You need the 2″x4″s, concrete, or cinder blocks that make up the structure of the home. That’s sort of what proteins are. They allow us to build—they’re what we need to heal when we’re injured, to grow when we’re young, or to get better when we’re under the weather. We require a fixed amount of protein per day to facilitate our healing, growth, or regeneration. Our needs are based on lean body mass—our total mass, less fat. A common ratio for necessary protein intake per day, in grams, is 0.7g per pound of lean body mass. This protein requirement is relatively constant, but may fluctuate slightly based on activity level, body composition goals, etc. For example, if you’re 120 pounds total, you might have a lean body mass of 100 pounds. Per the below formula, you’d need 70g of protein per day.

100 lbs lean body mass x 0.7g/lb = 70g of protein

Fat & Carbs: Diet Energy Sources

Fat and carbs provide an energy source. Just like a vehicle needs fuel, so do we. We fuel our activities, from blinking our eyes to running sprints, with fuel in the form of either carbs or fat.

Carbohydrates are a form of short-term energy. Carbs turn to glucose in the blood stream after digestion, where we can’t really ‘store’ it—it’s either use it or lose it. Unfortunately, in this case, ‘lose it’ means convert it to fat and save it for later. Sounds like a cruel trick, but it’s really an ingenious mechanism to make sure we have energy around the clock—even when we fast.

Fat has a little bit of a building block component and is also used to facilitate vitamin absorption, but for the most part, fat is used as energy. Fat is our long-term energy option. If we’ve got glucose in the blood stream from recently having eaten carbs, energy from fat isn’t accessible because glucose gets used first. Fat won’t be used as energy until we enter ketosis—when our bodies shift to using stored fat because we’ve exhausted glucose.

Hidradenitis Suppurativa Diet Macronutrient Balance

Remember earlier I stated that regardless of how we choose to makeup our diet, we can find good health? It’s because of balance. We need to pinpoint what our bodies need, and provide for those needs appropriately. In the case of HS, ‘appropriately’ means in a way that reduces inflammation. Take for instance the same 120 lb person from the last example, 70g of carbs satisfies the protein need, but still leaves another 1000 calories unaccounted for. On a vegan diet legumes might make up the protein, and a heavy starch like rice or potatoes can make up a big portion of the remaining calories. On a carnivore or keto diet, the protein might come from meat, while the other 1000 calories come from a fat like butter. The vegan will be full because a 1000 calories worth of rice would be difficult to eat at one time and would keep nearly anyone full even if spread out over the course of an entire day. The carnivore isn’t hungry because fat naturally suppresses hunger hormones and so the desire to eat might fade before the number of necessary calories for the day are even consumed. Getting the correct amount of protein and having enough calories from either starches or fat to supply our energy needs creates the balance in which our bodies thrive.

Inflammation Caused by Diet: Combining Fats & Carbs

Where we get into trouble with HS (and other health conditions) regarding diet, is when we combine fats and carbs. The fat/carb combo tastes great, but swings our blood sugar and hormone regulation completely out of equilibrium. Instead of balance, we end up totally out of whack! Our bodies constantly try to maintain a balance but the fat/carb-combo leads to inflammation because the wild swings in blood sugar and hormones induce stress. It’s not so much what direction we go with diet that’s important, just as long as we stay on that road. If we choose a direction (like vegan or carnivore as in the above examples), then flip-flop (especially on a regular basis like in yo-yo dieting) we end up more and more inflamed because our bodies are constantly striving for a balance that is rarely achieved. This is how a number of different diets end up contributing to systemic inflammation. It’s not that the diet isn’t useful, it’s just likely that our combination of fats and carbohydrates together is inhibiting the equilibrium we’re striving for. With this in mind, it presents us with two unique scenarios: first, if you’re in the habit of combining fats and carbs, regardless of what diet you’ve implemented, your diet may in fact be contributing to the inflammation that leads to HS symptom flare ups. Or second, if you are able to meet your protein and energy needs without combining carbohydrates and fats very often, and have done it long term—without improvement in HS symptoms—diet is likely not what’s contributing most to your inflammation. The latter scenario is where I believe a lot of HS sufferers miss the boat.

Stress and Hidradenitis Suppurativa

Hidradenitis Suppurativa Inflammation

First off, if diet isn’t working, don’t stop there. Don’t give up on using diet to help improve your health. But, at the same time, don’t stop searching for other options! You can continue to improve your diet by eating real food while you also research and learn more about other factors that contribute to inflammation. Before I go any further, I want to say right off the bat, this post is not an attack on the concept of diet helping people relieve HS symptoms. It’s also not an attack on people for whom diet works! There’s a whole group of people for whom diet has worked miracles regarding lessening HS symptoms. When it comes to overcoming HS, I am super happy that diet does work out for those people. However, not everybody has that experience.

The point I’m trying to make is that diet doesn’t resolve HS for everyone, and I want to give the people for whom it hasn’t worked hope. The way I do that is by discussing my experience and how stress ruined my health and contributed to my HS lesions. Unfortunately, I didn’t even realize I was stressed—until what was stressful in my life went away and my HS went away shortly after as well.

Looking back now, I can easily see that I was stressed. Unfortunately, when my dermatologist told me to avoid smoking, to stay thin, and to avoid stress—I didn’t know what stress looked like and was too ignorant to put any weight on that part of his suggestion. I never thought, “I’m really stressed out,” but I was under immense stress without even knowing it. The takeaway is, if you’re reading this thinking, “I’m not stressed out,” I hear you—because I was that person. And I want to stop you from making the same mistake I did. Now is a great time to take a moment and ask yourself: is it difficult to fall asleep at night, is it difficult turning off the noise inside your head, are there times where it feels hard to breathe? If so, maybe you’re stressed out too. I want to be able to speak to that, and bring to your attention that poo-pooing the concept that stress has something to do with your HS may cost you years of putting up with this disease. It certainly cost me years of my life that I feel were stolen from me. Preventing that feeling for you is really the whole point of this post. I want to put out there that diet isn’t the fix-all some people tout it to be, and focusing on diet alone may be a huge mistake. Not because it doesn’t work, but because it doesn’t work for everybody. Along the same vein, I’m not saying stress is causing everyone’s HS. What I am saying, is that if diet isn’t working, don’t stop there, look elsewhere! If diet hasn’t worked, stress is likely a very worthwhile focus point.

The Stress and Hidradenitis Suppurativa Connection

In an article titled Links Between Stress, Sleep, and Inflammation: Are There Sex Differences?the subject of stress and inflammation are discussed. There’s a lot of other data irrelevant to this post included as well, but regardless, one of the top findings is that psychological stress is associated with elevated systemic inflammation. Systemic and chronic inflammation are exactly what those of us with HS need to prevent and avoid, so the stress-inflammation link is critical. This article alone presents nearly all the info I needed to understand why when my stress resolved, my HS went into remission. It makes perfect sense.

In an article by the title of Stress and the Skin, a link is made between stress and a variety of skin disorders. In this specific article, HS isn’t mentioned, so there’s no data to show stress is a trigger for HS, but there are a bunch of other skin conditions listed which leads me to draw the conclusion that folks with HS simply weren’t included in the study. I believe this study backs up the inflammatory or inflammation theory of disease, where stress contributes to systemic inflammation and the specific skin condition itself is unique to each one of us based on what we’re genetically pre-disposed to. For instance, maybe I manifest my inflammation through HS, while somebody else may manifest their inflammation through eczema, psoriasis, or some other issue. Again, even though this article doesn’t list stress as a specific cause for HS, I believe a connections exists.

Similar to Stress and the Skin, an article titled Brain-skin connection: stress, inflammation and skin aging, says “Recent clinical observations also link psychological stress to the onset or aggravation of multiple skin diseases.” Given the other two articles, this isn’t at all surprising! Again, we’re following the same trend of what we feel on the inside affecting us on the outside. This is precisely why I believe when coming up with a strategy to win against HS, the best place to start is with our hearts. What we feel, what we think, what goes on inside of our head (and heart) manifests through our skin. How fascinating is this?! Especially when we consider the impact of stress and how it could potentially take what’s happening inside of us and manifest it on the outside through our skin. If you’re thinking this all sounds crazy, consider this: imagine facing a fear like flying or public speaking, as the fearful event gets closer, your palms get sweaty and you might even break into a cold sweat. In this instance, what’s going on on the inside—fear, or stress!—is manifesting on the outside. Sweaty palms are common when we get nervous. The same concept applies to extreme stress that builds slowly over time—only instead of just wiping away the sweat on our hands, we end up with painful lesions that may take years to fully heal.

Hidradenitis Suppurativa Remission

All of the above was super important for me to share, and I can’t stress enough if you believe that you’re not stressed, keep this post in the back of your mind. My HS has been in remission for years, but I do find that when I experience situations that crush me on the inside, that’s when I feel like HS might come roaring back to life. So whether it’s on a different part of my body or in a place that’s familiar, I can almost feel it happening again.

Hidradenitis suppurativa is like an indicator of overall health. Physical triggers like a poor diet or inflammatory foods might lead to new lesions, just like a traumatic life event might. It’s my opinion, that in relatively good physical health, and from a strong mental and spiritual position—where our hearts and bodies are at peace, or equilibrium across multiple different measures of health—leads to hidradenitis suppurativa remission. It’s up to us to learn, and to recognize when we are out of equilibrium, in our thoughts, in our heart, in our soul, and take action to remedy any discrepancies as quickly as possible.

Remission doesn’t look like never dealing with HS again, it looks like living a normal life and at the moment we begin to feel a new lesion coming on, being able to identify what’s wrong and addressing it before things get out of hand. There’s a learning curve, but this process gets easier over time as we get more familiar with the specific root cause(s) of our inflammation—in my case, what stresses me out the most. For me, remission looks like eating nightshades to my hearts content—but only as long as I’m not carrying a heavy burden on my heart. This is my remission because diet doesn’t contribute much to my level of inflammation. Turmoil—in relationships I value—wrecks me. That said, your remission might look much different than mine.

What’s Next?

For starters, don’t give up on diet, it doesn’t hurt to clean up what we’re taking in even if it’s not yielding the results we’ve been hoping for. Second, take a look at what’s stealing your peace. What’s keeping you up at night? What makes a day feel like it’s taking forever to end? What’s sucking the life out of you? If you’re comfortable, answer in the comments! Long story short, if diet hasn’t worked for you in the past, open up your mind to the concept that diet isn’t the only thing that contributes to inflammation, and that inflammation is the real issue for those of us with HS. Addressing stress worked for me and as a by-product my HS went into remission. I live my life normally now, without HS, and it’s fantastic! I whole-heartedly believe you can do the same. If that sounds good, use the form below to sign up for the HS Heart newsletter so we can keep in touch and you can win against HS.

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